AIDS in Maine (continued)

In Maine, where AIDS has been taken very seriously, it’s hard to believe that state government has been so slow out of the gate when it comes to outreach regarding a treatment that could potentially stem a growing epidemic, but local officials such as Noel Bonam, the manager for the Health and Human Services Department for the city of Portland, and Sandy Putnam, the nurse coordinator for the AIDS Consultation Program at Maine Medical Center, say that health officials, doctors, and emergency rooms are ready and able to treat patients with the life-saving drugs after assessing real risk. They have grabbed the baton, they’ve educated local officials, and they want to see you.

Putman, says that in Maine, clinics, primary-care physicians, and emergency rooms from St. Mary’s Hospital in Lewiston to Mercy Hospital in Portland are not only prepared to help, but have seen a spike in those seeking the drug regimen since the CDC announced the new guidelines.

"Are doctors aware? Absolutely. And so are people in the community," says Putnam. "This week I got a call from someone who said that he had had sex with someone who he knew was HIV positive, and he got semen in his eye, and he wanted to know if he should be treated." She adds that she received as many as three other requests for help in the same week.

"From there, the questions need to be very detailed to assess risk, such as when it happened and whether or not it was a true exposure. Regardless, though, is that it brings up all kinds of other questions like, ‘Why was there no condom in the first place?’ and ‘How can we work with this person to use condoms?’"

In the cum in the eye case, Putnam concluded that the risk was low, and recommended against treatment.

"I also knew the HIV+ patient and his CD4 [white-blood-cell count] and viral load. That’s very important. If we know that information, we know how virulent the [individual strain of the] virus is."

They also know something else: How to best treat the patient with what are dozens of drug combinations.

"Let’s say you had sex with someone you know and you know he is HIV+," posits Putnam. "If we can determine the CD4 count and viral load, and we know what meds he’s on, we’ll prescribe the same meds if they seem to be suppressing the virus in him. Otherwise, we’d assess work and life schedules because of the tough side effects. There isn’t just one regimen, and it’s all based on a person’s history."

And Putnam adds that treatment doesn’t end with a hunch and a script — there’s a lot more to it. "The people on these meds must be followed. You can’t just write a script and send them on their way," she says. "You must follow the drug regimen so closely, because the truth is that about 80 percent of people stop them because of side effects."

Bonam echoes Putnam with his assurance that doctors throughout the state are, by now, either aware how to treat and prescribe those who seek post-exposure prophylaxis or are savvy enough to phone someone who can help them muddle through the process, but he believes that more people should be accessing the treatment.

"We haven’t really seen that much of this. Yes, I think that the community is aware that this is available, but, for some reason, the community in general is very complacent to the risks that are out there and what they actually see as risks," says Bonam. "The trend is that we are seeing an increase in the number of people who are having sex with HIV+ partners and still being unprotected, but we’re not seeing a corresponding number of people seeking help from us."

An emergency room doctor at Mercy Hospital told the Phoenix that, to his knowledge, the hospital had only treated those who had had occupational exposure to HIV. But, he adds, many people would more likely seek treatment at Maine Medical. "People tend to gravitate towards Maine Med for this type of stuff," said the doctor who wished to remain anonymous. "But we have the packets in the ER. If this becomes more common, it would actually make it easier for us to put protocols in place. For now, we’d take it on a case-by-case basis, treat patients, and get them back in touch with a primary-care physician. Yes, we are prepared for this."

And a very informal poll of about 20 University of Southern Maine students, both gay and straight, revealed that only one of them had heard about post-exposure prophylaxis, yet every one of them said that if they knew that and they had been exposed to HIV, they would seek the treatment.

They might even contact the Frannie Peabody Center (formerly the AIDS Project), who are also prepared to point potentially infected individuals to the right health care.

"We actually started talking to Fenway before [the guidelines] came out, trying to get some protocols from other agencies and tailoring them to a smaller population," says Jennifer Putnam, the director of prevention at Peabody. "In fact, we had one particular case a while ago that seemed reasonable. The person was familiar with the agency, had had a one-time high risk, and we were able to connect that person to treatment. Then, we started to look at our ability to be able to do that on a bigger scale. So, when the guidelines came out, we were very excited."

But still somewhat ill-prepared. This week, Putnam and her colleagues have been assessing new protocols. For instance, they have identified that those who would call in for advice would likely do so on a Saturday, Sunday, or Monday morning — currently, there is no mechanism to take those calls.

"The efficacy goes way down after 48 hours. I think we’re gonna have to work that out," says Putnam. "That would be the time that we would be getting those calls, and we need to figure out how to put that into place."

That’s all good news.

The bad? A lot of people aren’t calling at all.

According to Sandy Putnam, there is a sinister side to the approach to HIV and AIDS by individuals in Maine, unlike anything she has seen in her 15 years doing this work. People are actually seeking infection. She says that she is aware of at least two groups of men in Maine who have sex parties every week, where condoms can be taboo, where crystal meth, the new drug of choice among thrill seekers, flows freely, and where, she says, men in Maine are looking to be "poz-ed," literally looking to be infected with HIV.

"It’s very scary," says Putnam. "I don’t want to make it analogous to the bath houses of the early days, but, well, it’s kinda like that."

Tony Giampetruzzi can be reached at tony@giampetruzzi.com

Part two of "AIDS in Maine, 2005," looking at what’s leading to a scary growth in the epidemic, will appear in the issue of March 18.